2021_Book_TextbookOfPatientSafetyAndClin

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causes of safety incidents and consequences of
unsafe primary care [2].
There is lack of a formal reporting mechanism
for medical errors in primary care. Incident
reporting is practiced as a self-reporting process
and the magnitude of errors could have been
underestimated. Among existing strategies to
help improve clinical effectiveness and enhance
patient safety there are the Quality and Outcomes
Framework (QOF), appraisal, revalidation, significant
event analysis (SEA), and critical incident
reporting systems (CIRS) One of the first
comprehensive and coordinated attempts to
improve patient safety in primary care is the
Scottish Patient Safety Program in Primary Care
(SPSP-PC), established in March 2013.
Recent years have seen more researches
located in primary care settings which have different
features compared to secondary care.
Attempts to classify medical errors and preventable
adverse events in primary care have proved
challenging due to the lack of an evidence base
and are yet to be reliably quantified. Data on the
most frequent misdiagnosed conditions are
scarce, and little is known about which diagnostic
processes are most vulnerable to breakdown.
Most of them are derived from studies of malpractice
claims or self-report surveys. These
methods introduce significant biases that limit
the generalizability of findings to routine clinical
practice [4].
Many countries have implemented strategies
to reduce avoidable harm or “never event” defined
as “a serious, largely preventable patient safety
incident that should not occur if the available preventable
measures were implemented by healthcare
workers.” In 2014, De Wet published a never
event list based on general practice identified
eight items (Mistaken patient identity, Acts of
omission, Investigations, Medication, Medicolegal
and ethical incidents, Clinical management
Practice systems, Teamwork and communication)
and, if there is some evidence of reduction
of patient safety incidents in some item of never
event list, it is unclear whether all of the never
events in the list are truly preventable, or which
of the available interventions will be acceptable
or effective [5, 6].
E. Alti and A. Mereu
The difficulties in identifying and monitoring
the never event list is due to the specific context
of General Practice.
“Marshall Marinker has characterised the role of
the GP as being to ‘marginalise danger’, contrasting
this with the specialist, whose diagnostic role is
to ‘marginalise uncertainty’. In other words GPs
have the often difficult task of identifying the
minority of patients whose presenting symptoms
represent serious illness from the majority who do
not have something seriously wrong” [7].
Patients in primary care setting can have many
health problems (multimorbidity), complex
needs (both social and medical), and frequent
interactions with healthcare staff in a number of
different clinical contexts. There is a range of
challenges for GPs, due to the specific primary
care setting based on deliver optimal disease
management and patient-centered care in a timelimited
consultation. The many and varied diseases
encountered in primary care make
comprehensive measurement of guideline adherence
difficult (especially for guidelines that
change frequently). Decision-making in primary
care often relies on complicated care algorithms
specific to numerous diseases. The complexity
and inadequacy of single disease guidelines,
evidence- based medicine and barriers to shared
decision-making were managed through the use
of relational continuity of care.
This peculiar care relationship involves a
many patient factors, including sex, age, the
nature of the illness, earlier experiences and perceived
control on the illness, education, financial
considerations, personal values, and cultures and
traditions [8].
Studies suggests inappropriate care with
patients presenting the same conditions, as a
result of gender, ethnicity, or socioeconomic disparities
and some vulnerable social groups are
more likely to experience adverse patient safety
events. A recent research confirms that, in primary
care, women and black patients are more
likely to receive inappropriate diagnosis, treatment,
or referrals compared to men and Whites,
respectively. However, our findings interestingly
suggest that social disparities in patient safety
vary among social groups depending on the type
of disease, treatment, or health service [9].